- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT04892563
Erector Spinae Plane Block for Rib Fracture Analgesia in the Emergency Department
Rib fractures, while in isolation are self-limited and benign, can be exquisitely painful. Poorly controlled rib fracture pain can compromise respiratory function leading to increased morbidity and mortality, especially in the elderly. Currently, opioid medications are the mainstay of analgesia but are associated with significant adverse effects, such as respiratory depression and delirium. In an effort to improve acute pain in the ED and concomitantly reduce opioid use, ultrasound-guided regional anesthesia has been implemented more frequently The erector spinae plane block (ESPB) is a relatively new ultrasound-guided procedure for thoracic analgesia.
Previously, the serratus anterior plane (SAP) block has been used for this indication. However, typical anatomical distribution limits the effectiveness of the SAP block to anterior rib fractures, while the majority of traumatic rib fractures are posterior, thus require a more central blockade such as the proposed ESPB. The ESPB can be done as a single injection into the superficial structures of the back under ultrasound guidance and as such, is a both a relatively safe and technically easy procedure to perform, especially in comparison to the more traditional alternatives of epidurals, paravertebral and intercostal injections.
There have been no prospective studies evaluating the efficacy and safety of the ESPB in the emergency department setting for acute rib fractures. The investigators hypothesize that the ESPB will provide improved acute pain scores in the emergency department compared to parental analgesia alone. Secondarily, investigators hypothesize that this will translate to less inpatient opioid requirements and improved incentive spirometry values.
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Undersøgelsestype
Tilmelding (Forventet)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
- Navn: Dana Sajed
- Telefonnummer: 858 361 4685
- E-mail: sajed@usc.edu
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age >=18
- At least 1 acute rib fracture. Acute defined as within 7 days of presentation.
- Numerical pain score on presentation at least 5 out of 10. This will identify patients that justify the invasive procedure.
- Admitted to hospital for at least 24 hours of observation.
- Be able to consent and participate in study by assuming necessary positioning for intervention
Exclusion Criteria:
- Hypotension/shock (shock index >1.0, SBP < 90)
- Distracting injury not amenable to ESPB as determined by the enrolling physician. (i.e extremity fracture, burn, laceration, contusion, joint dislocation, etc.)
- Examples of patients not able to consent/participate are intubated patients or patients in spinal precautions (i.e c-collar)
- Known hypersensitivity to local anesthetic
- Evidence of infection at the proposed site of injection
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
---|---|
Eksperimentel: ESPB Block
Patients with rib fracture randomized to block group
|
Nerve block with local anesthetic in the erector spinae plane
Andre navne:
|
Aktiv komparator: Standard Care
Patients with rib fracture receiving IV analgesia/standard care
|
IV analgesia, typically Morphine/Opioid medications
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
To determine the effectiveness of the ESPB for pain management of acute rib fractures in the emergency department using a 10 point isual analog scale
Tidsramme: 0, 1, 2 and 24 hours assessment
|
Change in pain level from fractures as measured using a visual analog scale
|
0, 1, 2 and 24 hours assessment
|
Samarbejdspartnere og efterforskere
Efterforskere
- Ledende efterforsker: Tom Mailhot, MD, LAC+USC Medical Center
Datoer for undersøgelser
Studer store datoer
Studiestart (Forventet)
Primær færdiggørelse (Forventet)
Studieafslutning (Forventet)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Patologiske processer
- Sår og skader
- Sygdomsegenskaber
- Thoracale skader
- Flere traumer
- Nødsituationer
- Brud, Knogle
- Ribbenbrud
- Brud, multiple
- Lægemidlers fysiologiske virkninger
- Depressive midler til centralnervesystemet
- Agenter fra det perifere nervesystem
- Analgetika
- Sensoriske systemagenter
- Analgetika, Opioid
- Narkotika
- Morfin
Andre undersøgelses-id-numre
- HS-21-00066
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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Kliniske forsøg med Multipel ribbenbrud
-
Charles University, Czech RepublicAfsluttetMuskelhypertoni | Rib syndromTjekkiet
-
Assiut UniversityAfsluttetKnoglebrud; Rib, MultipleEgypten
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Assiut UniversityUkendtKnoglebrud; Rib, Multiple
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Ospedali Riuniti TriesteIkke rekrutterer endnuRibbenbrud | Rib TraumaItalien
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Brittany HoyteRekrutteringRibbenbrud | Multipel ribbenbrud | Rib TraumaForenede Stater
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University Hospital MuensterRekrutteringRibbenbrud | Multipel ribbenbrud | Rib Trauma | Thorax; KnoglebrudTyskland
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AMS Centro Medico del EjercicioAfsluttet
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Chang Gung Memorial HospitalAfsluttetRibbenbrud | Hæmotorax; Traumatisk | Rib Trauma
-
George Washington UniversityRekrutteringSmerter, Akut | Ribbenbrud | Multipel ribbenbrud | Rib TraumaForenede Stater
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Denver Health and Hospital AuthorityAfsluttetLungebetændelse | Anæstesi, lokal | Lægemiddeleffekt | Opioidafhængighed | Kirurgisk procedure, uspecificeret | Ribbenbrud | Lokal infiltration | Nervesmerter | Rib Trauma | Smerte; Kateter (andet) | Interkostal ribben | Brystskade TraumeForenede Stater
Kliniske forsøg med Erector Spinae Plane Block
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Ankara UniversityThe Scientific and Technological Research Council of TurkeyAfsluttetThorakotomi | Forebyggende analgesi | Erector Spina Plan Block | Nociception Level Index (NoL)Kalkun
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Firat UniversityRekruttering
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Eskisehir Osmangazi UniversityAfsluttetSmerter, postoperativ | Postoperative komplikationerKalkun
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Diskapi Yildirim Beyazit Education and Research...AfsluttetPostoperativ smerteKalkun
-
Diskapi Teaching and Research HospitalAfsluttet
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Atatürk Chest Diseases and Chest Surgery Training...AfsluttetSmerter, postoperativ | Thorakotomi | Erector Spinae Plane Block | Serratus anterior plane blokKalkun
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Tokat Gaziosmanpasa UniversityUkendtSmerter, postoperativ | Restitutionsperiode, anæstesi | Mastektomi
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Tribhuvan University Teaching Hospital, Institute...Ikke rekrutterer endnu
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Diskapi Teaching and Research HospitalAfsluttetMyofascial smerte | TriggerpunktKalkun
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Ankara UniversityAfsluttet